Paediatric trauma - NAI

Question 1

what are the most common types of fractures in children?

Answer 1

Greenstick AND Salter-harris.

Question 2

3 typical sx/sy of a fracture

Answer 2

pain, swelling, deformity

Question 3

4 aspects of Mx

Answer 3

xray, rest, ice, compress, elevate, plaster cast.

PRICEM – protected weight bearing, rest, ice, compression, elevation, medication’s (analgesia, NSAID’s) and if these don’t work then consider surgery. Use PRICEM pneumonic to remember the conservative Mx

Question 4

advice to patients to help prevent further accidents

Answer 4

encourage regular exercise, healthy diet, wear safety equiptment, appropriate supervision.

Question 5

what are the Fracture principles for children?

Answer 5

1. childrens. Fractures are often simple, incomplete and quickly heal. (metabolically active periosteum, cellular bone, plastic, don’t overtreat or over mobilise, fixation isnt usually required)
2. remodel well in the plane of joint movement (appositional periosteal growth, differemtial physeal growth).
3. a thick periosteal hinge is usually a friend.
4. fractures involving physes can result in progressive deformity.

Question 6

types of forarm fractures

Answer 6

shaft, galeazzi, monteggia, distal radial

Question 7

on assessment

Answer 7

hx of mechanism of injury, deformity, soft tissue involvement - wounds, sensation, vascular status

Question 8

complications of forearm fracture?

Answer 8

compartment syndrome (volkmanns), nonunion, refracture, radioulnar synostosis, PIN injury, superficial radial nerve injury.

Question 9

distal radius buckle, torus…

Answer 9

failure of 1 cortex in compression

Question 10

distal radius greenstick

Answer 10

failure of 1 cortex in compression and the other cortex in extension, looks like someones been winded.

Question 11

Mx

Answer 11

Cast

Question 12

ddx for a knee trauma

Answer 12

infection, inflammatory arthropathy, neoplasm, apophysitis, hip, foot, sickle, haemophilia.

Question 13

where does physeal injury commonly occur

Answer 13

Distal femur below physis –Prox tibia below physis

Question 14

how is physeal arrest mx

Answer 14

Resect Bar, Complete epiphysiodesis, Contralateral epiphysiodesis, Corrective osteotomy

Question 15

outline a tibial spine fracture…

Answer 15

Overlap with ACL
• Meyers & McKeever
– I Undisplaced
– II Hinged
– III Displaced

Question 16

ogden types of tibial tubercle

Answer 16

• Ogden classification:
– I Distal avulsion
– II To prox tibial physis
(not joint)
– III To prox tibial physis
(into joint)

Question 17

patellar dislocation

Answer 17

• Risk factors: Laxity, Poor VMO, Q angle, Femoral anteversion, Tibial ext rotation, Patella alta. tx = Cast 2/52 - Repair medial ligament
–Mobilise - Lateral release
–VMO exercises - Medialise tibial tubercle

Question 18

ankle fractures

Answer 18

Physis as plane of fracture
• Physis weaker than Ligaments
• Growth arrest risk History – Mechanism
• Deformity
• Soft tissues
• AP & lateral radiographs – Ottawa
rules Management - ORIF, - Monitor for growth arrest

Question 19

transitional ankle fractures

Answer 19

• Tillaux: – External rotation, – anterior tibiofib lig avulsion, – SH3, – Closed/Open reduction
• Growth plate closing, age 13-14y: –Central>Medial>Lateral fusion, –Articular congruity over Physeal, integrity Triplane, – External rotation, – SH3 on AP + SH2 on lat = SH4, – 2 - 3 - 4 part, – CT, ORIF

Question 20

name some overuse injuires

Answer 20

Osgood-Schlatter’s Disease, Sever’s Disease.

Osgood–Schlatter disease is inflammation of the patellar ligament at the tibial tuberosity. It is characterized by a painful bump just below the knee that is worse with activity and better with rest.

Question 21

what is a salter harris fracture?

Answer 21

A Salter–Harris fracture is a fracture that involves the epiphyseal plate or growth plate of a bone, specifically the zone of provisional calcification. It is thus a form of child bone fracture. It is a common injury found in children, occurring in 15% of childhood long bone fractures.